APPLICATION FORM

  Name

 Address

 City 

State

Zip

  Phone # 

Age (on June 27)

Please select one race:

                                       5K-Run      1-Mile Walk   

Gender: Male Female  

T-Shirt Size S M L XL XXL (ADD $2)

 I certify that I am in good health and have trained for this event.  In consideration of your acceptance of this entry, I hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the organization holding this competition, their agents, representatives, successors, and assignors for any and all injuries by me at said competition

 By checking this box I submit my approval to this former statement.

 By checking this box I, the undersigned parent or legal guardian of the competitor, hereby approve and confirm the above waiver and release.

 Parent or Guardian Name

On-Line applications will be held

for receipt of entry fee. 

 Placement on the Race Roster is subject to receipt of payment.